Real Experiments Research Articles

Cannabis Sativa Oil Promotes Social Interaction and Ultrasonic Communication by Acting on Oxytocin Pathway.

Objective: Cannabis sativa is the most used recreational drug worldwide. In recent years, there has been a growing interest in the potential therapeutic benefits of medicinal cannabis to treat a variety of psychiatric and neurological conditions. In particular, cannabidiol (CBD), a nonpsychoactive cannabis constituent, has been investigated for its potential prosocial effects on behavior, although the molecular mechanisms underlying this effect are still largely unknown. The aim of this study was to investigate the effect of a C. sativa oil CBD rich (CS oil) on social interaction and ultrasonic communication in mice. Study Design: Twenty-seven adult male mice (B6; 129P F2) were treated daily with vehicle or CS oil for 2 weeks. At Day 14, mice were tested for behavior (social interaction test and ultrasonic communication). Forty minutes before the behavioral tests, mice were exposed to intranasal treatment with vehicle or the oxytocin receptor antagonist, L-371,257. After behavioral tests, VH- and CS oil-treated mice were sacrificed, RNA was extracted from the hypothalamus and used for quantitative Real Time-PCR experiments. Results: We found that a 2-week treatment with the CS oil on mice exerted a prosocial effect associated with an increase in ultrasonic vocalizations. These effects were inhibited by pretreating mice with an oxytocin receptor antagonist. In addition, at the molecular level, we found that CS oil treatment caused a significant increase in oxytocin and a decrease in oxytocin receptor expression levels in the brain hypothalamus. Conclusion: Our results suggest that CS oil promotes social behavior by acting on oxytocin pathway.

Two-Phase Fuzzy Real-Time Approach for Fuzzy Demand Electric Vehicle Routing Problem with Soft Time Windows

Environmental concerns have called for several measures to be taken within the logistics and transportation fields. Among these measures is the adoption of electric vehicles instead of diesel-operated vehicles for personal and commercial-delivery use. The optimized routing of electric vehicles for the commercial delivery of products is the focus of this paper. We study the effect of several practical challenges that are faced when routing electric vehicles. Electric vehicle routing faces the additional challenge of the potential need for recharging while en route, leading to more travel time, and hence cost. Therefore, in this work, we address the issue of electric vehicle routing problem, allowing for partial recharging while en route. In addition, the practical mandate of the time windows set by customers is also considered, where electric vehicle routing problems with soft time windows are studied. Real-life experience shows that the delivery of customers’ demands might be uncertain. In addition, real-time traffic conditions are usually uncertain due to congestion. Therefore, in this work, uncertainties in customers’ demands and traffic conditions are modeled and solved using fuzzy methods. The problems of fuzzy real-time, fuzzy demand, and electric vehicle routing problems with soft time windows are addressed. A mixed-integer programming mathematical model to represent the problem is developed. A novel two-phase solution approach is proposed to solve the problem. In phase I, the classical genetic algorithm (GA) is utilized to obtain an optimum/near-optimum solution for the fuzzy demand electric vehicle routing problem with soft time windows (FD-EVRPSTW). In phase II, a novel fuzzy real-time-adaptive optimizer (FRTAO) is developed to overcome the challenges of recharging and real-time traffic conditions facing FD-EVRPSTW. The proposed solution approach is tested on several modified benchmark instances, and the results show the significance of recharging and congestion challenges for routing costs. In addition, the results show the efficiency of the proposed two-phase approach in overcoming the challenges and reducing the total costs.

Graph neural network based abnormal perception information reconstruction and robust autonomous navigation

PurposeThis paper aims to develop a robust navigation enhancement framework to handle one of the most urgent needs for real applications of autonomous vehicles nowadays, as these corner cases act as the most commonly occurred risks in potential self-driving accidents.Design/methodology/approachIn this paper, the main idea is to fully exploit the consistent features among spatio-temporal data and thus detect the anomalies and build residual channels to reconstruct the abnormal information. The authors first develop an anomaly detection algorithm, then followed by a corresponding disturbed information reconstruction network which has strong robustness to address both the nature disturbances and external attacks. Finally, the authors introduce a fully end-to-end resilient navigation performance enhancement framework to improve the driving performance of existing self-driving models under attacks and disturbances.FindingsComparison results on CARLA platform and real experiments demonstrate strong resilience of the authors’ approach which enhances the navigation performance under disturbances and attacks.Originality/valueReliable and resilient navigation performance under various nature disturbances and even external attacks is one of the most urgent needs for real applications of autonomous vehicles nowadays, as these corner cases act as the most commonly occurred risks in potential self-driving accidents. The information reconstruction approach provides a resilient navigation performance enhancement method for existing self-driving models.

Real life experience with point by point pulsed field ablation for recurrent ventricular arrhythmias

Abstract Introduction The safety and effectiveness of electroporation/point by point pulsed field ablation (PP PFA) as emerging technoloy for catheter ablation (CA) of ventricular arrhythmias (VAs) has been described till now only in case reports. Purpose The aim of this observational retrospective study is to present real life data concerning the overall performance of PP PFA for CA of recurrent VA. Methods A total number of 13 consecutive patients (11 VTs and 2 PVCs), in whom recurrent VTs after RF ablation documented, were included. In all patients the substrate location was documented beforehand based on cardiac MRI or CT with myocardial thinning. For substrate mapping a high resolution multipoint mapping catheter was used. A complete success was defined as non inducibility of any arrhythmia at the end of procedure respectively lack of VA recurrence at follow – up. Results Excepting 2 patients, all other had a non ischemic cardiomyopathy as underlying heart disease (mean age 63 ± 8 y/o, mean LVEF 42 % ± 9 %). In every patient at least one conventional RF CA has been performed previously (mean 2 ± 1) and 38 % of patients had a previous epicardial RF VT ablation. The PP PFA VT ablation was performed endocardialy in 11 patients (84 %), respectively epicardialy in 2 patients. The ablation sites had a septal location in 53 % of patients and other localisation in 47 % of patients. The applied energy was 25 A. The overall acute complete success was achieved in 77 % patients. At medium 6 ± 3 months follow up a complete success was present in 46 % cases. Most frequently a VT recurrence after PP PFA ablation was encountered in patients with combined septal and nonseptal substrate distrubution. After PP PFA, the RF CA strategy due to recurrent VAs was endocardial in 2 patients, respectively epicardial 2 in cases and bipolar in 1 case. No PP PFA redos were undergone. Three major complications have been documented (1 tamponade, 1 AV block III° and 1 complete LBBB). Conclusion As bailout strategy in patients with failed conventional CA, PP PFA represents a safe strategy. Specific complications like temporary atrioventricular or intraventricular conduction disturbancies are extremely rare, reversible but not life threathening. The midterm success is satisfactory but still limited in patients with intramural substrate.

Perspectives on Optimized Transcranial Electrical Stimulation Based on Spatial Electric Field Modeling in Humans.

Background: Transcranial electrical stimulation (tES) generates an electric field (or current density) in the brain through surface electrodes attached to the scalp. Clinical significance has been demonstrated, although with moderate and heterogeneous results partly due to a lack of control of the delivered electric currents. In the last decade, computational electric field analysis has allowed the estimation and optimization of the electric field using accurate anatomical head models. This review examines recent tES computational studies, providing a comprehensive background on the technical aspects of adopting computational electric field analysis as a standardized procedure in medical applications. Methods: Specific search strategies were designed to retrieve papers from the Web of Science database. The papers were initially screened based on the soundness of the title and abstract and then on their full contents, resulting in a total of 57 studies. Results: Recent trends were identified in individual- and population-level analysis of the electric field, including head models from non-neurotypical individuals. Advanced optimization techniques that allow a high degree of control with the required focality and direction of the electric field were also summarized. There is also growing evidence of a correlation between the computationally estimated electric field and the observed responses in real experiments. Conclusions: Computational pipelines and optimization algorithms have reached a degree of maturity that provides a rationale to improve tES experimental design and a posteriori analysis of the responses for supporting clinical studies.

Capture of emotional responses under a simulated earthquake experience using near-infrared spectroscopy and virtual reality.

In a previous study, we reported that watching two-dimensional videos of earthquakes significantly reduced sympathetic nerve activity in healthy young adults. In the present study, we aimed to investigate the emotional responses to earthquakes using immersive virtual reality (VR), which can provide a more realistic experience. In total, 24 healthy young adults (12 males, 21.4 ± 0.2 years old) participated. Participants were required to watch earthquake and neutral videos while wearing a head-mounted display and near-infrared spectroscopy (NIRS), during which physiological signals, including pulse rate and cerebral blood flow (CBF) in the dorsolateral prefrontal cortex, were measured. We also analyzed changes in sympathetic and parasympathetic indices and obtained seven emotion ratings: valence, arousal, dominance, fear, astonishment, anxiety, and panic. The VR earthquake videos evoked negative subjective emotions, and the pulse rate significantly decreased. Sympathetic nerve activity tended to decrease, whereas CBF in the left prefrontal cortex showed a slight increase, although this was not significant. This study showed that measurements combined with NIRS and immersive VR have the potential to capture emotional responses to different stimuli.

Context Awareness Assisted Integration System for Land Vehicles

Accurate context awareness of land vehicles can assist integrated navigation systems. Motion behavior recognition is one context awareness of vehicles, based on which constraint information helps reduce the impact of short-term blockage of navigation signals on radio-frequency-based positioning systems. To improve the reliability of behavior recognition, we proposed a machine learning-based vehicle motion behavior recognition and constraint method (MLMRC). The machine learning-based recognition process is directly driven by raw data from low-cost MEMS-IMU, while the traditional threshold-based method relies on previous experience. Four categories of constraint information—sensor error calibration, velocity constraint, angle constraint, and position constraint—were constructed from the recognition results. Both the simulated vehicle experiment and real vehicle experiment demonstrate the performance of the MLMRC method. When there is a short-term blockage, the MLMRC method can reduce the positioning error from 17.2% to 38.3% compared with the traditional method, which effectively improves positioning accuracy and provides support for autonomous vehicles in complex urban environments.

Immersive distance simulation: Exploring the educational impact of stereoscopic extended reality (XR) video in remote learning environments

What was the educational challenge? There is a growing need for healthcare simulation options when local expertise or resources are not available. To connect instructors with remote learners, current options for distance simulation are typically limited to videoconferencing on desktop computers or mobile devices, which may not fully capture the complexity of clinical scenarios. What was the solution? Extended reality (XR) technology may provide a more immersive and realistic distance healthcare simulation experience compared to traditional videoconferencing options. Unlike computer- or phone-based video calls, stereoscopic video in XR provides a sense of depth that may increase spatial understanding and engagement in distance simulation. How was the solution implemented? We investigated the impact of XR for synchronous distance simulation compared to traditional desktop-based videoconferencing in Emergency Medicine (EM) resident training for an obstetrical emergency. A randomized controlled experiment was conducted with half of the residents using XR and half using computers to participate in the simulation. What lessons were learned that are relevant to a wider global audience? There was an unanticipated interaction between postgraduate year and condition such that performance in the XR condition was superior for first year residents, while this was reversed for more experienced residents. This indicates that the benefits of XR might be dependent on participant characteristics, such as learner level. What are the next steps? We plan to extend this research to clarify characteristics of learners and tasks that are important determinants of differences in outcomes between stereoscopic XR versus traditional videoconference displays.

#2662 Octreotide-LAR in ADPKD patients with very low kidney function: a monocentric real-life experience

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, characterized by development of fluid-filled renal cysts leading to progressive expansion of kidney volume, with decline in kidney function up to end-stage renal disease (ESRD). Octreotide long-acting release (OCT-LAR) is a synthetic somatostatin analogue, which has been shown to reduce kidney and cysts growth and to slow the progression of kidney function decline in ADPKD patients. Although the evidence of the literature supporting the protective effect of the OCT-LAR against progression of the disease in ADPKD patients with both early and later-stages, to date no data are available in ADPKD patients treated with this somatostatin analogue in a real-world clinical setting. In August 2018 OCT-LAR was approved only in Italy for the treatment of ADPKD adult patients with eGFR ranging from 30 to 15 mL/min/1.73 m2 at elevated risk of progression towards ESRD. The present study is aimed to report for the first time the effects on renal function of OCT-LAR in ADPKD patients with severe renal insufficiency (stage 4 CKD) receiving this somatostatin analogue for therapeutic indication in a real-world clinical setting. Method We conducted a retrospective, ADPKD-population-based cohort study using healthcare data from the medical records of patients with ADPKD referred to the Department of Nephrology of University “Federico II” of Naples from November 2018 to April 2023 aimed to analyse within-patient clinical outcomes, including eGFR decline, before and after treatment with OCT-LAR. We include adult ADPKD patients (≥18 years) with GFR (eGFR) between 30 and 15 mL/min/1.73 m2, stably treated from at least 1 years with the regular dose of OCTR-LAR. The primary endpoint was the assessment of eGFR decline from 1 year before the start of the treatment (T-1) to baseline (T0), and after 1 year of therapy with OCT-LAR (T1) in the overall population and in two subgroups of patients with eGFR ≥ or < 25 ml/min/1.73 m2. Results 31 ADPKD patients were analysed (18 with eGFR ≥ 25 and 13 with eGFR < 25). Compared to pre-treatment period, eGFR decline significantly slowed during therapy with OCT-LAR in both eGFR groups (Table 1), while no difference was found between eGFR groups. After the first year of observation, 7 patients required dialysis (all with eGFR <25). Conclusion This is the first study reporting the effects of OCT-LAR on eGFR of ADPKD patients with advanced chronic kidney disease (CKD) in a real-world clinical setting. Our results suggest that, compared the last year of follow-up pre-treatment, OCT-LAR slows eGFR decline after 1 year.

#1042 A real-life experience with dapagliflozin in the treatment of patients with IgA Nephropathy at high risk of progression

Abstract Background and Aims Even though IgA nephropathy is the most common primary glomerular disease worldwide, being accounted with 22% of kidney biopsy results in Europe and despite great advances in comprehending its pathogenesis, little has changed in the standard of care over the last decades. According to recent studies, dapagliflozin reduced the progression of chronic kidney disease in chronic forms of IgA Nephropathy. The study sought to investigate the impact of dapagliflozin use in a compiled cohort of patients diagnosed with IgA Nephropathy. Method This is a prospective, observational study, that included 52 patients with IgA Nephropathy, based on a prior kidney biopsy, actively monitored from 2021 to 2023, in the Nephrology Department of Fundeni Clinical Institute, Bucharest. The inclusion criteria were: patients with IgA nephropathy diagnosed upon evaluation of a kidney biopsy, with GFR>30 ml/min/1.73 m2 and proteinuria above 0.3 g/day, who received dapagliflozin 10 mg, daily, with a follow-up of 6 and 12 months. The baseline parameters were considered those that were on the onset of SGLT2 inhibitors therapy with dapagliflozin. Results The study population had a mean age of 48 ± 11 years old and 69.2% were male. The mean value of baseline serum creatinine was 1.68 ± 0.75 mg/dl and the mean value of GFR was 54 ± 27 ml/min/1.73 m2, while the mean value of baseline proteinuria was 1.55 ± 2.1 g/day. Also, the risk of chronic kidney disease progression was very high in 59.6% cases, high in 34.6% cases and moderate in 5.8% cases. The majority of the study cohort (90.4%) already received a stable dose of angiotensin-converting-enzyme inhibitors or angiotensin receptor blocker. After 6 months of dapagliflozin administration, the absolute decline of proteinuria was 0.94 ± 1.9 g/day, while after 12 months was 1.06 ± 2.97 g/day, which in terms of percents translates as a decline of—44.7% and—50%, respectively. A mild decrease in GFR was observed, the absolute decline being represented by 4 (−6.25; 3) ml/min/1.73 m2 after 6 months and 3.5 (−9;2) ml/min/1.73 m2 after 12 months. Patients who had proteinuria less than 1 g/day at baseline experienced an absolute decline in GFR with 2.5 (−5.75; 3.75) ml/min/1.73 m2, while the study group with proteinuria above 1 g/day had an absolute decline in GFR of 5 (−7.2; 3) ml/min/1.73 m2 after 6 months, while after 12 months of treatment, the GFR drop was 4 (−8.5;1.5) ml/min/1.73 m2 and 3 (−9;2) ml/min/1.73 m2, respectively. A GFR decline over 30% was observed with a prevalence of 17.6% in the group with proteinuria above 1 g/day and 9.5% in the group with proteinuria under 1 g/day, while the prevalence was 8.7% in the group with GFR>45 ml/min/1.73 m2 and 20% among the group with GFR<45 ml/min/1.73 m2. The mean value of baseline proteinuria was 0.42 ± 0.21 g/day in the cohort with proteinuria<1 g/day and 3.09 ± 2.53 g/day in the cohort with proteinuria>1 g/day (p < 0.001). At 6 months, the absolute decrease of proteinuria was 0.18 ± 0.18 g/day in the group with proteinuria under 1 g/day and with 1.79 ± 2.53 g/day in the group with proteinuria above 1 g/day (p < 0.001), whereas after 12 months it was 0.15 ± 0.21 g/day and 2.17 ± 2.54 g/day (p < 0.001); also, after 12 months, proteinuria was reduced with 1.42 ± 2.37 g/day at patients with GFR>45 ml/min/1.73 m2 and with 0.48 ± 0.85 g/day at patients with GFR<45 ml/min/1.73 m2, a difference which tends to reach statistical significance. Conclusion There was a decline in proteinuria after 6 months and 12 months of dapagliflozin treatment, with a statistically significant difference between the two groups: the patients with proteinuria above 1 g/day experienced a more remarkable reduction than the group with proteinuria under 1 g/day. Patients with GFR>45 ml/min/1.73 m2 experienced a higher drop in proteinuria. A mild decrease of GFR was noticed during the follow-up period, with a higher prevalence of a GFR dip over 30% in the group with proteinuria above 1 g/day and with GFR<45 ml/min/1.73 m2, but the difference was not statistically significant.

Rapid response on facial psoriasis to bimekizumab: case series.

Psoriasis is a chronic inflammatory disease that can affect any part of the body but, when it appears in certain areas, like the face, it can have a very significant psychological impact. Biologics, in particular IL-17 and IL-23 drug inhibitors, have shown relevant clinical efficacy in the management of psoriatic lesions in difficult-to-treat areas. In post hoc analysis of phase III trials in plaque psoriasis, bimekizumab has shown safety and complete clearance of high-impact areas. However, these studies did not focus on the effect of bimekizumab on facial lesions. Therefore, this case series represents the first clinical real-life experience of rapid and successful management of facial psoriasis with bimekizumab in six patients.

#1327 mTOR inhibitors in kidney transplant recipients: long-term efficacy and discontinuation causes

Abstract Background and Aims mTOR inhibitors use in kidney transplantation showed conflicting results, but their use as add-on treatment to calcineurin inhibitors (CNI) is still considered a valuable option. High frequency of drug discontinuation hinders their use in clinical practice. We present a real-life study on long term efficacy of mTOR inhibitors use vs mycophenolic acid (MPA) and the causes of drug discontinuation. Method This is an observational retrospective monocentric study. We analyzed data from 773 patients that underwent kidney transplantation at Hospital Clinic between 2013 and 2019. Induction treatment was based either on basiliximab or a lymphocyte-depleting agent together with methylprednisolone. Maintenance treatment was based either on MPA or mTORi with a CNI. Baseline differences were accounted for with the Inverse Propensity of Treatment Weighting (IPTW). Outcomes explored were death with a functioning graft, graft loss or biopsy-proven rejection. Predictors of outcome were explored through logistic regression or Cox-regression as appropriate. Results 335/773 (43.3%) of the patients received MPA as maintenance treatment, whereas 438/773 (56.6%) received an mTOR inhibitor. Average follow-up was 3.36 years (SD ± 2.04 years). No outcome resulted statistically significant at the logistic regression weighted with IPTW in the subgroup mTORi vs MPA: odds ratio was 1.16 (0.75-1.63, p = 0.57) for death, 0.87 (0.54-1.41, p = 0.59) for graft loss and 1.15 (0.79-1.67, p = 0.45) for biopsy-proven acute rejection. The per-protocol analysis confirmed these results as not statistically significant. Strongest predictors of death resulted having a deceased donor of cardiac death (HR 2.17 (1.06-4.40, p = 0.03), having a delayed graft function (HR 1.9 (1.26-2.87, p = 0.002) and being readmitted within three months from the surgery (HR 1.76 (1.21-2.55, p = 0.003). Diabetic nephropathy as cause of kidney disease was significant as well (HR 2.01 (1.24-3.26, p = 0.004). Proportion of patients with a CMV infection were significantly lower in the mTORi than MPA subgroups (33.5% vs 41.5%, p = 0.02). Proportion of patients developing neoplasias were not significantly different (10% vs 11.3%, p = 0.55). A total of 307/773 (39.7%) of patients changed their immunosuppressive treatment at a median time of 110 days (26.5-375.5). In the MPA subgroup 77/335 (22.9%) changed treatment, whereas in the mTORi subgroup 230/438 (52.5%). The causes of change due to drug-related events were the most represented and related to mTOR treatment: lymphocele in 36/773 (4.6%), complications of the surgical wound in 31/773 (4.1%) and edemas in 23/773 (2.9%) were the most common. Of note, unspecific physician preference was cause of discontinuation in a total of 66/773 (8.5%) patients. Conclusion Our data from a tertiary-center, real-life experience show that mTOR inhibitors are a solid alternative to MPA based protocols, with effectiveness proven at the multivariate and weighted analysis. mTOR treatment has a high rate of discontinuation, with most of the causes represented by post-intervention complications; interestingly, physician preference represent a frequent cause. Further experience and research is needed to optimize mTORi treatment, in order to maintain a therapeutic option for transplanted patients.

Virtual Digital Metaverse Healthcare Assistant

The healthcare industry has grown more quickly as a result of the quick advancements in automation and digitization. These developments have produced innovative models that open up new avenues for providing treatment at a lower cost. A new digital technology called the Metaverse has enormous promise for the healthcare industry by giving patients and medical professionals realistic experiences. The Metaverse is an intersection of many enabling technologies, including robotics, quantum computing, internet of medical devices, augmented reality, virtual reality, and artificial intelligence, that allow new avenues to be explored for delivering high-quality healthcare services and treatments The integration of these technologies guarantees patient care that is immersive, individualized, and intimate. Additionally, it offers sophisticated, adaptable solutions that break down boundaries between healthcare practitioners and recipients. A thorough analysis of the Metaverse for healthcare is given in this article, with special attention to the state of the art, technologies that make it possible to use the Metaverse for healthcare, possible uses, and associated initiatives. Future research areas should address these concerns as well as highlight potential solutions for adapting the Metaverse for healthcare applications

Effectiveness and safety of risankizumab in VEry severe plaque psoriasis: a real-life retrospective study (VESPA-Study)

Background The recent introduction of biological drugs specifically targeting the interleukins involved in psoriasis pathogenesis revolutionized the therapeutic scenario of moderate to severe forms of psoriasis. Among these, risankizumab, an anti-IL-23, was shown to be effective both in clinical trials and real-life experiences. However, data on its use on very severe forms of psoriasis, defined by a Psoriasis Area Severity Index (PASI) of at least 30, are scant. In this context, our study aimed to investigate the outcomes of patients with very severe psoriasis, and the involvement of difficult-to-treat areas treated with risankizumab for up to 2 years. Methods A retrospective, observational study enrolled patients with very severe plaque psoriasis and the involvement of difficult-to-treat areas undergoing treatment with risankizumab. Clinical and demographic data were collected at baseline. Moreover, at baseline and each dermatological examination (16, 28, 40 and 104 weeks), clinical improvement was measured using the percentage of patients achieving PASI 75/90/100 response, site-specific Psoriasis Global Assessment and Dermatology Life Quality Index. Results At baseline, the mean PASI was 35.1 ± 5.1. A significant reduction was observed since week 16 and maintained up to week 104. Moreover, the Psoriasis Global Assessment and Dermatology Life Quality Index improved as well. Conclusions Risankizumab showed to be effective and safe in patients affected by very severe forms of psoriasis with the involvement of difficult-to-treat areas.

Cadaveric Simulation in Rib Plating is Beneficial for Helping Surgical Trainees to Assimilate New Technologies.

Rib fixation procedures are being performed more frequently as they have shown multiple advantages over traditional non-operative management in well-selected patients. We have developed a rib-fixation simulation on cadavers for use by surgical residents in attempt to improve their comfort, knowledge and ability to use this new technology. Residents in years 3 through 5 of training attended a rib-fixation simulation course with cadavers. Trauma faculty and representatives of manufacturers of rib-fixation hardware participated. The simulation consisted of groups of residents reviewing anatomy and creating adequate exposure for the entire procedure. Each group created rib fractures in the cadaver, determined which materials were needed, and then performed the rib-fixation procedure. Following the simulation, we surveyed the residents to determine the impact of the structured cadaveric rib fixation-based course on their comfort level. The survey was performed using a four- and five-level Likert questionnaire. The results were analyzed using paired t-tests. Of the participating residents, 72% of residents had performed five or fewer rib-fixation procedures in their training in the first cohort, while in the cohort for the following year, 65% had performed 5-10 procedures. The simulation had a statistically significant benefit to the residents' comfort level with rib plating (2.5 versus 3.6, p-value: 0.003). The greatest impact on the comfort level was seen in year 3 of training (2 versus 4, p-value 0.02). One hundred percent of residents found that having faculty and representatives present for the simulation was very helpful. The survey demonstrated that most residents gained new knowledge regarding the anatomy and technical dissection. In 20 of 25 encounters, residents strongly agreed that this simulation was beneficial for their surgical education, when used in addition to real operative experience. Every resident reported that they would recommend the simulation to younger resident classes. Rib-fixation simulations on cadavers were beneficial for surgical residents' self-assessed comfort level. The simulation increased residents' knowledge, comfort, and ability to perform rib-fixation procedures. We have seen a significant increase in resident participation in these cases after simulation training. Based on these findings, we will continue to incorporate these simulations into our program's curriculum.

Ten years' real-life experience on the use of multikinase inhibitors in patients with advanced differentiated thyroid cancer.

To evaluate objective response rates (ORR), progression-free survival (PFS), and overall survival (OS) associated with tyrosine kinase inhibitors (TKIs) in patients with radioiodine refractory differentiated thyroid cancer (RR-DTC). Additionally, to compare: (i) ORR and PFS among patients treated with lenvatinib and sorafenib; (ii) ORR and PFS among patients receiving lenvatinib as first-line vs. second-line and; (iii) adverse effects (AEs) observed in patients treated with these medications. Retrospective analysis of RR-DTC adult patients treated with TKIs at the Division of Endocrinology, Hospital de Clinicas, University of Buenos Aires (March 2011-November 2023). Among 43 patients included in the study, 32 received sorafenib (30 as first-line and 2 as second-line), while 29 received lenvatinib (12 as first-line and 17 as second-line). The median PFS and OS for the entire cohort were 32.7 and 39.0 months, respectively. Lenvatinib demonstrated a significantly higher ORR compared to sorafenib (37.9% vs. 9.4%, p = 0.008). However, both drugs exhibited similar median PFS (23.2 vs. 16.0 months, p = 0.419). No significant difference was observed in ORR and PFS between patients receiving first-line vs. second-line lenvatinib. Sorafenib-treated patients experienced higher rates of hand-foot skin syndrome (69% vs. 41%, p = 0.032) and alopecia (25% vs. 3%, p = 0.018), whereas lenvatinib-treated patients had higher rates of proteinuria (31% vs. 0%, p < 0.001) and grade 3 hypertension (31% vs. 9%, p = 0.034). TKIs demonstrated efficacy and tolerability comparable to real-world data in RR-DTC. PFS was not statistically different between sorafenib and lenvatinib. Our study will help guide physicians in making informed decisions regarding treatment sequencing with TKIs in these patients.

A 12-month longitudinal naturalistic follow-up of cariprazine in schizophrenia.

Cariprazine, a third-generation antipsychotic (TGAs), has demonstrated efficacy in the treatment of schizophrenia with good tolerability profile. Actual real-world literature data are lacking, particularly when exploring its efficacy in the long term. The present study examined the effects of cariprazine treatment on specific psychopathological domains with a particular focus on outcomes and side effects in real-life experience, after a long-term treatment. The present 12-month longitudinal naturalistic study included a sample of subjects with a DSM-5-TR diagnosis of schizophrenia, recruited in the outpatients' psychiatric services of university and community hospitals in Italy, naturally treated with cariprazine. The assessments included: a sociodemographic data sheet, the Structured Clinical Interview for the DSM-5 (SCID-5), the Positive and Negative Symptom Scale (PANSS) and the St. Hans Rating Scale (SHRS). The PANSS was also administered after 6 (T1) and 12 (T2) months of treatment with cariprazine while the SHRS at T1. The total sample consisted of 31 patients, 15 males and 16 females. A significant decrease of the PANSS' subscales, Marder factors and total mean scores emerged at both T1 and T2 with respect to T0. Extrapyramidal symptoms occurred in a minority of patients and in mild or mild/moderate forms: no patient showed moderate forms of psychic/motor akathisia or dystonia, three subjects showed moderate parkinsonism. This study confirms a good efficacy profile of cariprazine in both positive and negative symptoms in patients with Schizophrenia, combined with a good tolerability profile in extrapyramidal symptoms.

When covalent organic frameworks meet zeolites: Enhancing rhodamine B removal through the synergy in the emerging organic–inorganic nanoadsorbents

The development of new porous materials has attracted intense attention as adsorbents for removing pollutants from wastewater. However, pure inorganic and organic porous materials confront various problems in purifying the wastewater. In this work, we integrated a covalent organic framework (TpPa-1) with an inorganic zeolite (TS-1) for the first time via a solvothermal method to fabricate new-type nanoadsorbents. The covalent organic framework/zeolite (TpPa-1/TS-1) nanoadsorbents combined the merits of the zeolite and COF components and possessed efficient adsorptive removal of organic contaminants from solution. Structural morphology and chemical composition characterization by powder X-ray diffraction, scanning electron microscopy, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, transmission electron microscopy and thermogravimetric analysis demonstrated the successful preparation of TpPa-1/TS-1 composite nanoadsorbents. The resultant composite adsorbent TpPa-1/TS-1 removed rhodamine B at 1.7 and 2.6 times the efficiency of TpPa-1 and TS-1, respectively. Additional investigation revealed that the Freundlich adsorption isotherm and the pseudo-second-order kinetic model could be employed to represent the adsorption process more appropriately. Thermodynamic calculation analysis showed that the adsorption process proceeded spontaneously and exothermically. Besides, the effects of pH, absorbent mass and ionic strength on the adsorption performance were systematically investigated. The prepared composite adsorbent showed a slight decrease in removal efficiency after eight cycles of repeated use, and real water environment experiments also showed the high stability of the adsorbent. The enhanced performance can be attributed to electrostatic interaction, acid-base interaction, hydrogen bonding and π–π interactions.

The Application of Artificial Intelligence in Visual Communication in the Context of Cross-boundary Fusion

In the context of cross-border integration, significant progress has been made in the application of artificial intelligence in the field of visual communication. Through methods such as image recognition and processing, video analysis and understanding, and posture recognition and action capture, artificial intelligence not only improves the accuracy and efficiency of visual communication, but also brings innovative solutions to multiple industries. In the field of security monitoring, artificial intelligence has achieved high accuracy in facial and vehicle recognition, improving the efficiency of security monitoring; In the field of telemedicine, artificial intelligence helps doctors diagnose conditions more accurately through video analysis, improving communication efficiency; In the VR/AR field, artificial intelligence provides users with a more natural and realistic interaction experience through posture recognition and motion capture technology. These applications not only demonstrate the potential of artificial intelligence in visual communication, but also provide strong support for cross-border integration and innovative development in more fields in the future. Meanwhile, with the continuous advancement of technology and the expansion of application scenarios, we hope that artificial intelligence can play a greater role in the field of visual communication, bringing more convenience and value to society.

Cybersecurity threats in tourism and hospitality: perspectives from tourists engaging with sharing economy services

ABSTRACT In recent years, the number of cyber-attacks has increased significantly, affecting various business sectors, including tourism and hospitality. However, research on cybersecurity in tourism remained scarce. The current study aims at investigating cybersecurity threats from tourists’ perspectives while using sharing economy services. Using snowball sampling method and considering the ‘real experience of cybercrime’ as inclusion criterion, a total number of 14 in-depth interviews with tourists from different parts of the world were conducted online and data were analysed thematically through the lens of Protection Motivation Theory. The findings uncovered the heightened susceptibility of both tourists and sharing economy services to an array of cyber-attacks, encompassing side jacking, Point-of-sale attacks, insecure transactions, personal data breaches, phishing, etc. These multifarious threat vectors significantly complicate effective responses. In line with PMT, several themes, including threat appraisal, coping appraisal (perceived efficacy, response efficacy and response costs), self-protection and behavioural decision-making, have emerged. The results further indicate that high vulnerability attributes to tourists unfamiliarity and restricted cognizance of destination-specific elements such as regulatory framework, financial systems and technological infrastructure. Tourists’ reactions to cybercrimes exhibit variability contingent upon the typologies of threats or attacks, contextual factors, prevailing conditions and their geographic disposition during the occurrence.